Promotion Of Exclusive Breastfeeding Research Articles

Exclusive human milk feeding and prevalence of early adiposity rebound in ELBW infants: a retrospective cohort study

The purpose of the present study was to evaluate the prevalence of early adiposity rebound (EAR) and factors associated with its occurrence in a cohort of extremely low birth weight infants (ELBW). We conducted a retrospective longitudinal study including ELBW infants followed-up for up to 10 years after discharge. EAR was defined as occurring before 5 years of age. A multivariate binary logistic regression analysis was performed to evaluate maternal and perinatal variables independently associated with EAR. Out of 212 ELBW infants included in the analysis, 40.6% developed EAR and 21.5% showed it before 4 years of age. Only formula milk feeding at discharge was independently associated with a higher risk of EAR. The mean BMI of children with EAR was higher than that of children without EAR. Furthermore, the prevalence of overweight and obesity was higher in the EAR group than in the timely AR group.  Conclusions: ELBW infants in our cohort developed EAR in a relatively high percentage of cases. In this already at-risk population, EAR may represent a further risk factor for an adverse metabolic outcome. Monitoring preterm infants’ growth within a long-term follow-up program and promoting and supporting human milk feeding is advisable.What is Known:• Preterm-born infants are at high risk for long-term adverse health outcomes, especially cardiovascular and metabolic.• The occurrence of early adiposity rebound (EAR) is associated with the risk of later obesity and metabolic syndrome.What is New:• The occurrence of EAR in ELBW infants may represent an additional risk factor for later adverse metabolic outcomes in an already vulnerable population.• Future preventive strategies should include a long-term follow-up and the promotion of exclusive breastfeeding.

Antenatal and perinatal service delivery associations with breastfeeding outcomes in Nepal: Analysis of the 2016 Nepal Demographic and Health Survey

Infant and Young Child Feeding (IYCF) breastfeeding guidelines of the World Health Organization (WHO) have been promoted in Nepal since the early 1990s. This study investigated whether antenatal and perinatal service delivery in Nepal are associated with early initiation of breastfeeding and age-appropriate feeding practice (exclusive breastfeeding to six months; introduction of complementary foods at six months with continued breastfeeding to two years). Data from the 2016 Nepal Demographic and Health Survey (NDHS) were analysed using multivariable logistic regression. The unit of analysis was an interviewed woman and her last-born child aged 0-23 months. We examined number of antenatal visits, place and type of delivery, infant-mother skin-to-skin contact post-delivery, and breastfeeding observation and counselling by a healthcare provider within two days post-delivery. Of 1938 mother-infant dyads, 1073 (55.4%) commenced breastfeeding within one hour of delivery and 1665 (85.9%) were engaged in age-appropriate feeding. Breastfeeding within one hour of delivery was associated with infants delivered vaginally (aOR: 4.76, 95% CI: 2.96-7.65), infant-mother skin-to-skin contact post-delivery (aOR:2.10, 95% CI: 1.63-2.72) and observation of breastfeeding by a healthcare provider within two days post-delivery (aOR: 1.58, 95% CI: 1.20-2.08). Age-appropriate feeding was lowest amongst mothers with infants aged 4-5 months (40.8%) compared to those with infants aged 0-1 month (aOR: 0.158, 95% CI: 0.083-0.302). Antenatal and perinatal service delivery were not significantly associated with age-appropriate feeding. Further promotion of infant-mother skin-to-skin contact post-delivery (including after caesarean delivery) and observation of early breastfeeding may increase the rate of breastfeeding within one hour of delivery. Promotion of exclusive breastfeeding in antenatal and perinatal services and additional postnatal support should be considered to increase exclusive breastfeeding of infants to six months. These improvements may be achieved through enhanced implementation of the Baby Friendly Hospitals Initiative and effective training and sufficient practice for skilled birth attendants.

Rol de la Facultad de Ciencias Médicas en la promoción de la puericultura en la ciudad de Córdoba (1877 - 1918)

Introducción: Desde su fundación, la Facultad de Ciencias Médicas (FCM, UNC, Argentina) y sus miembros participaron en el diseño y la aplicación de políticas públicas eugénicas destinadas a evitar la despoblación y disminuir la mortalidad infantil. El presente trabajo describe dichas políticas desde la fundación de dicha institución hasta el inicio del proceso de Reforma Universitaria. Materiales y Métodos: Se realizó un análisis bibliográfico de bases de datos online y catálogos de bibliotecas para identificar textos referidos a políticas de puericultura y salud pública promovidas por la FCM en el período 1877 - 1918. Resultados: Se obtuvieron un total de 11 referencias bibliográficas: tres libros, dos artículos publicados en revistas científicas y seis Tesis para optar al título de Doctor en Medicina y Cirugía de la FCM. Discusión: Se evidencia en los textos analizados un gran interés en la caracterización de la mortalidad infantil en Córdoba y la promoción de la lactancia materna exclusiva. A ello se asocia la creación y administración de instituciones de salud de puericultura entre los que se destaca el Consultorio Protector de la Infancia. Conclusiones: La FCM, ligada a grupos políticos cordobeses, participó activamente en la difusión de los conceptos de puericultura (cuyas destinatarias eran principalmente las mujeres-madres de estratos socioeconómicos carenciados) y en la implementación de acciones tendientes al crecimiento poblacional y la inculcación de valores morales aceptados por sus académicos.

Predictors of cessation of exclusive breastfeeding according to the Cox regression model: survey of mothers of children aged 6-12 months, Thiès, Senegal.

even though exclusive breastfeeding (EBF) for up to six months is recognised as essential infant care, it is still insufficiently practiced. The objective of this study was to identify predictors of EBF cessation in Thiès. this was a survival analysis of data collected using a cross-sectional procedure. Data collection took place from 2nd December 2019 to 21st January 2020. The study population consisted of mothers of children aged 6 to 12 months residing in Thiès and seen at the reference health centre of the Thiès Health District during infant vaccination sessions. The number of subjects was 400 mothers recruited using a systematic survey, with a sampling interval equal to two. Data were collected through a face-to-face interview. Predictive factors were identified using the Cox regression model. The adjusted hazard ratio (AHR) and its 95% confidence interval (95% CI) are calculated. the average age of the mothers was 27.08 ± 6.34 years. The proportion of mothers who breastfed their child within one hour of birth was 29.25%. The proportion of those who practiced EBF was 41.50%. The incidence density of EBF cessation was 14 person-months per 100 breastfeeding mothers. The median duration of EBF was 5 months. Lack of advice on EBF during antenatal care (AHR=1.42; 95% CI =1.08-1.85), sources of information other than health professionals (AHR =1.51; 95% CI =1.05-2.19), late initiation of EBF, i.e. breastfeeding beyond 24 hours after birth (AHR =1.53; 95% CI =1.02-2.28) and low level of knowledge about EBF (AHR =1.46; 95% CI =1.11-1.92) were significantly associated with early termination of EBF. the promotion of EBF for up to six months will necessarily involve the promotion of prenatal consultations during which professionals should raise awareness among future mothers.

Surgical implications of HIV infection

According to the joint United Nations Programme on HIV/AIDS (UNAIDS), 37.7 million adults and children worldwide were estimated to be living with HIV or acquired immune deficiency syndrome (AIDS) at the end of 2020 [UNAIDS. (2022). http://www.unaids.org . Accessed 30 May 2022]. Most reside in low- and middle-income countries, with approximately 67% in sub-Saharan Africa (SSA). At the end of 2020, the total number of children less than 15years of age living with HIV infection was 2.6 million, of whom 2.3 million (88%) were living in SSA. Aggressive interventions have reduced the annual number of incident (new) HIV infections among children to around 150,000 [UNAIDS. (2022). http://www.unaids.org . Accessed 30 May 2022]. However, paediatric HIV infection remains a pandemic affecting children predominantly in SSA but is also seen in Asia and sporadically elsewhere particularly in areas of civil strife such as is currently the case in Ukraine [War in Ukraine. (2022). https://www.unaids.org/en/War-Ukraine-special . Accessed Apr 2022]. New HIV infections among children declined by more than half (54%) from 2010 to 2020, due mainly to the increased provision of antiretroviral therapy to pregnant and breastfeeding women living with HIV [UNAIDS. (2022). http://www.unaids.org . Accessed 30 May 2022]. These programmes include early identification of HIV infection in pregnant or breastfeeding women through routine HIV testing, provision of antiretroviral therapy (ART) to all HIV-infected women who are pregnant or breastfeeding, provision of antiretroviral prophylaxis to their newborn infants during the first 6-12weeks of life, delivery by elective Caesarean section when indicated, promotion of exclusive breastfeeding, early infancy screening for HIV infection, and initiation of ART in infants with HIV infection. HIV-infected children may require surgery either as an emergency to deal with a life-threatening incidental condition unrelated to HIV infection or for a complication of the disease such as tuberculosis or an aggressive soft tissue infection like necrotising fasciitis. Non-emergency surgical procedures may be required to assist in the diagnosis of an HIV-related condition or to correct a routine surgical problem electively. Surgical conditions associated with HIV infection are described under categories of soft tissue or organ-specific infections requiring drainage or debridement; gastrointestinal tract disease and complications; infections in the perineal area; malignancies and HIV-associated vasculitis. Although surgical outcomes are less favourable in HIV-infected children, pre-operative treatment of coinfections, administration of cotrimoxazole prophylaxis, nutritional support and antiretroviral therapy, together with peri-operative antibiotic prophylaxis have resulted in excellent short-term outcomes [World Health Organization. Consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV infection: Recommendations for a public health approach, June 201 http://www.apps.who.int/iris/bitstream/10665/85321/1/9789241505727_eng.pdf?ua=1 ; World Health Organization Guideline on when to start antiretroviral therapy and on pre-exposure prophylaxis for HIV, September 2015. http://www.apps.who.int/iris/bitstream/10665/186275/1/9789241509565_eng.pdf?ua=1;Eley et al. in BMC Infect Dis 2:3, 2002;Karpelowsky et al. in Pediatr Surg Int 28:1007-1014, 2012;].

The Rates of Breastfeeding in Baby-Friendly Hospitals in Greece: A Nationwide Survey.

Exclusive breastfeeding (EBF) remains the cornerstone of infant nutrition for the first six months of life, presenting multiple short and long term benefits. The purpose of this study is the demonstration of EBF rates of infants born in baby-friendly hospitals (BFH) and the factors that positively influence EBF. The study was conducted in all four of the BFH that exist in Greece, between 2020 and 2022. The study sample consisted of 1200 mothers, taken from the 7101 that delivered at those hospitals during the time of the study. A questionnaire was used that included questions to evaluate the infant's nutrition after birth, after exiting the maternity hospital and during the 2nd, 4th and 6th month of age. The WHO guidelines on EBF and breastfeeding (BF), as well as the "Infant and Young Child Feeding" indicators, were used. The EBF rate within 1 h after birth was 71.3%, which gradually declined to 21.2% in the 6th month. The respective rate of BF was 94.5% and declined to 66.1%. The logistic regression revealed that attending antenatal breastfeeding courses, vaginal delivery, full-term pregnancies and the mothers' advanced education level constitute independent positive prognostic factors for increased EBF rates. The results of the first national study on BFH are presented. Despite the improvement of EBF rates in Greece, compared to the latest available data from 2018, reinforcement of EBF promotion measures is required in order to approach the WHO's targets by 2025.

Burden, Clinical Characteristics, Risk Factors, and Seasonality of Adenovirus 40/41 Diarrhea in Children in Eight Low-Resource Settings

BackgroundThe application of molecular diagnostics has identified enteric group adenovirus serotypes 40 and 41 as important causes of diarrhea in children. However, many aspects of the epidemiology of adenovirus 40/41 diarrhea have not been described.MethodsWe used data from the 8-site Etiology, Risk Factors, and Interactions of Enteric Infections and Malnutrition and the Consequences for Child Health and Development Project birth cohort study to describe site- and age-specific incidence, risk factors, clinical characteristics, and seasonality.ResultsThe incidence of adenovirus 40/41 diarrhea was substantially higher by quantitative polymerase chain reaction than enzyme immunoassay and peaked at ∼30 episodes per 100 child-years in children aged 7–15 months, with substantial variation in incidence between sites. A significant burden was also seen in children 0–6 months of age, higher than other viral etiologies with the exception of rotavirus. Children with adenovirus 40/41 diarrhea were more likely to have a fever than children with norovirus, sapovirus, and astrovirus (adjusted odds ratio [aOR], 1.62; 95% CI, 1.16–2.26) but less likely than children with rotavirus (aOR, 0.66; 95% CI, 0.49–0.91). Exclusive breastfeeding was strongly protective against adenovirus 40/41 diarrhea (hazard ratio, 0.64; 95% CI, 0.48–0.85), but no other risk factors were identified. The seasonality of adenovirus 40/41 diarrhea varied substantially between sites and did not have clear associations with seasonal variations in temperature or rainfall.ConclusionsThis study supports the situation of adenovirus 40/41 as a pathogen of substantial importance, especially in infants. Fever was a distinguishing characteristic in comparison to other nonrotavirus viral etiologies, and promotion of exclusive breastfeeding may reduce the high observed burden in the first 6 months of life.

Breastfeeding Rates and Related Factors at 1 Year Postpartum in Women With Gestational Diabetes Initially Recruited for a Diabetes Prevention Program

ObjectivesOur aim in this study was to evaluate breastfeeding up to 1 year postpartum and factors related to weaning in women with recent gestational diabetes mellitus (GDM). MethodsWe assembled a cohort study of women with GDM enrolled in prenatal clinics of the Brazilian National Health System as possible candidates for the Lifestyle Intervention for Diabetes Prevention After Pregnancy (LINDA-Brasil) postpartum trial (N=2,220). Sociodemographics and clinical and nutritional information, including breastfeeding, were obtained by interview or chart review. Follow-up by telephone was done at specific intervals during the first year postpartum. ResultsThe probability of breastfeeding at 1 year postpartum, estimated from Kaplan–Meier survival analysis, was 53.5%. Cox regression models showed increased risk of weaning for those introducing milk or formula before 6 months (hazard ratio [HR], 2.55; 95% confidence interval [CI], 2.10 to 3.09); reporting problems in breastfeeding (HR, 1.49; 95% CI, 1.22 to 1.82); being Caucasian (HR, 1.46; 95% CI, 1.21 to 1.76); smoking during pregnancy (HR, 1.68; 95% CI, 1.28 to 2.20); and living in 2 southern cities of Brazil (HR, 1.58; 95% CI, 1.16 to 2.16; and HR, 1.76; 95% CI, 1.20 to 2.58). ConclusionsAbout half of the women with GDM ceased breastfeeding before 1 year postpartum, a rate matching that of the general population in Brazil. The main risk factor was not exclusively breastfeeding up to 6 months. Given the possibility of curbing diabetes risk by maintaining longer breastfeeding, further promotion of exclusive breastfeeding up to 6 months for these high-risk women is much needed.

Impact of Health and Nutrition Interventions in the Prevention and Recovery of Child Malnutrition in Sub-Saharan Africa from 2010 to 2020: Review Article

Malnutrition is still a widespread public health problem worldwide. The objective of this review is to identify the most effective nutrition programs used in the prevention and management of child malnutrition in children under five years. Also, it is to suggest courses of action to improve interventions in the fight against malnutrition. The promotion of exclusive breastfeeding and food diversification improves the mothers’ knowledge and contributes to prevention of malnutrition. Food supplementation increases the weight/height ratio of malnourished children. The two programs combined bring better results on mothers’ feeding practices and children’s anthropometric data. This review has highlighted the importance of food supplementation and nutritional education in the management and prevention of child malnutrition. In addition, the combination of several approaches to good dietary practices brings better results. Finally, primary prevention can protect children from the harmful consequences of malnutrition.

The risk factors associated with rotavirus gastroenteritis among children under five years at university of maiduguri teaching hospital, Borno State, Nigeria

Background: Diarrhea is a major cause of childhood morbidity and mortality in both developing and developed countries. It remains a common cause of hospitalization worldwide. Rotavirus is a cause of acute watery diarrhea in children under five years of age. The incidence of diarrhea decreases with increasing age. Aim: This study aimed at finding some risk factors associated with rotavirus infection in children Patient, Materials and Methods: This is a cross-sectional study. A total of 173 children Results: The Source of water supply and presence of persons with gastroenteritis in the household were found to be risk factors for acquiring the infection with statistically significant P < 0.05. Breastfeeding was found to be protective of rotavirus gastroenteritis. Conclusion: Rotaviruses cause morbidity and mortality in children under five years of age. In view of the associated risk factors, making available safe drinking water and encouraging good personal hygiene is important. Promotion of exclusive breastfeeding and vaccination is advocated. Public health strategies like creating awareness to affected communities are a good strategy.

Teaching strategies and learning environments for breastfeeding promotion: a scoping review

Introduction:The promotion of exclusive breastfeeding (EBF) up to the age of 6 months has become a global public health issue due to its benefits for newborns and mothers. As a result, WHO and UNICEF expect that by 2030, 75% of children will be fed breast milk. However, the recommendations for its promotion are still generalized.Objectives:To describe teaching strategies and environments conducive to women’s learning of EBF implemented by care professionals.Methods:This review was based on articles published between June 2012 and January 2020. Three databases (CINAHL, PubMed, and Embase) were queried.Results:A total of 7,710 articles were pre-selected, of which 78 met the criteria for final selection. Educational interventions were mostly diversified, empirical, and without pedagogical engineering. However, the presence of pedagogical alignment regarding teaching strategies seems to have a favorable effect on the choice of breastfeeding and its duration at medium and long term.Conclusion:These results, coupled with the exploitation of experience-based knowledge in the field of breastfeeding, should lead to an initial pedagogical model. Evaluated according to critical realism, this should make it possible to identify the key functions that will enrich the tested pedagogical model and ensure its transferability.

Prevalence of exclusive breastfeeding and associated factors among mothers in Surman City a cross-sectional study

Background: Exclusive breastfeeding (EBF) means that the infant receives only breast milk for the first six months of life after birth. The objective was to assess the prevalence of EBF and associated factors among mothers having children aged 0–6 months in Surman city, Libya. Methods: A cross-sectional study was conducted in Surman city among 146 mothers of infants aged 0–6 months. Eligible mothers were identified and randomly selected using the demographic surveillance system’s computerized database that is updated weekly. A semi-structured questionnaire was used for interviews that inquired information on socio-demographic characteristics, obstetric, health service, breastfeeding related factors (initiation of breastfeeding, prelacteal feeding and colostrum feeding) and economic factors. EBF prevalence was calculated using 24-hour recall method. Multivariate logistic regression analysis was used to identify those factors associated with the Exclusive breastfeeding. Results: The prevalence of EBF in the last 24 hours preceding the survey was 44.5%. Significant evidence of an association was observed with type of delivery, assistance during delivery and fathers' education with (OR = 0.664, 95% CI 0.461, 0.957, p=0.027), (OR =0.593, 95% CI 0.422, 0.835, p=0.007) and (OR= 2.500, 95% CI 1.161,2.925 P= 0.041) respectively. Age, Mothers’ education, Initiation of breastfeeding, were found to be not associated with breastfeeding practices. Conclusion: The prevalence of EBF Surman city (44,5%) is lower than Global Nutrition Targets 2025, increase the rate of EBF in the first 6 months up to at least 50%. Most (66.4%) of the mothers reported that they had not received breastfeeding education during their last pregnancy and 94.5% percent of mothers had not antenatal care visits, (54.8%) were Caesarean deliveries These findings suggest that there is a need for breastfeeding support provided by health services. Hence, promotion of EBF during the first six months of life needs to be addressed and future breastfeeding promotion programs should give special attention to those women who are not practicing EBF

HUBUNGAN PENGETAHUAN DAN SIKAP IBU MENYUSUI DENGAN PEMBERIAN ASI EKLUSIF DI PUSKESMAS DARUSALAM

Promotion of Exclusive Breastfeeding has actually been active for a long time, but the reality is that government programs have not run as expected. Therefore, the purpose of this study was to determine the relationship between knowledge and attitudes of breastfeeding mothers with exclusive breastfeeding at the Darussalam Health Center in 2020. This type of research is an analytic survey with a cross sectional approach. The total population is 195 breastfeeding mothers who have babies aged 0-6 months at the Darussalam Health Center and a sample of 66 people. Sampling using accidental sampling technique. Collecting data through interviews using a questionnaire. Data processing with editing, coding, scoring, and tabulating processes. Analytical data analysis, presented in univariate data analysis and bivariate data analysis. For bivariate data, analyze the relationship between variables using chi square. The results showed that from 66 breastfeeding mothers there were 48 breastfeeding mothers (72.7%) who gave exclusive breastfeeding, 26 breastfeeding mothers (39.4%) who had sufficient knowledge about exclusive breastfeeding, 53 breastfeeding mothers (80.3%). who have a positive attitude about exclusive breastfeeding. There is no relationship between knowledge of breastfeeding mothers and exclusive breastfeeding, with the results of the chi-square test, X2 count &lt; X2 table (1.4 &lt;5.591) and there is a relationship between the attitudes of breastfeeding mothers and exclusive breastfeeding, with the results of the chi-square test, where X2 count &gt; X2 table (34.72 &gt; 3.841). The conclusion of this study is that the majority of breastfeeding mothers who give exclusive breastfeeding are 48 people, the majority of breastfeeding mothers have sufficient knowledge, 26 people, and the majority of breastfeeding mothers have a positive attitude 53 people. There is no relationship between knowledge of breastfeeding mothers and exclusive breastfeeding and there is a relationship between attitudes of breastfeeding mothers and exclusive breastfeeding. It is hoped that breastfeeding mothers and the community can improve attitudes in giving exclusive breastfeeding.

A Path Analysis to Identify Factors Influencing the Provision of Water in Addition to Breast Milk by Mothers of Infants under Six Months of Age in Conakry and Kindia Regions, Republic of Guinea

Water provision to infants under six months of age (IU6M) can hamper exclusive breastfeeding (EBF). Understanding factors and their relationships influencing this practice is needed to tailor EBF promotion programs. Using a validated questionnaire, this study aims to identify pathways in which individual factors and the environment interact to affect the provision of water in addition to breast milk among 300 mothers of IU6M. Our finding shows that 75% of mothers intended to provide water in addition to breast milk to their IU6M and that about 60% reported doing it. Results of the final path show that the subjective norm/SN (β = 0.432, p &lt; 0.001), the attitude (β = 0.349, p &lt; 0.001), and to a lesser extent the perceived control/PC (β = 0.141, p = 0.005) predict the intention of mothers to provide water in addition to breast milk to their IU6M. The environment scores predict the attitude (β = 0.210, p = 0.001) and the SN (β = 0.284, p &lt; 0.001). Having the mother practicing early breastfeeding initiation at birth positively predicted the PC score (β = 0.157, p = 0.017) and predicted an increasing score of SN (β = 0.221, p = 0.003). Even though predicting the final behavior is complex, this research provides directions to nutrition education programs to tailor their content to the context and be more efficient in reducing the proportion of women providing water to their IU6M, hence contributing to the improvement of EBF.

488Trial design and statistical considerations for a trial comparing group and individual treatments

Abstract Focus of Presentation A randomized clinical trial is considered the best experimental study design for comparing the effect of an intervention against a control. Selecting a trial design depends on the trial objective, a better choice would be a design that provides optimal estimation of the intervention effect, i.e. a design that yields smaller variance for the estimated intervention effect and giving stable estimates. The choice of analysis method depends on trial design aspects, reasonable assumption on the underlying probabilistic model generating the data and the credibility of findings depend on the appropriateness of the analysis method used. Here, we describe a planned randomized standard of care-controlled trial on interactive weekly mobile text messaging added to a motivational interviewing intervention aimed at sustaining continued breastfeeding among women living with HIV in South Africa. Under the “findings” heading, we highlight some of the trial design and statistical issues for discussion at the early career workshop, to gain insights on possible approaches to address the methods issues. Methods and trial design: Women from peri-urban informal settlements and a rural setting will be invited to participate within 24 hours of giving birth at selected primary healthcare facilities. Eligible women will be individually randomized to intervention or control arm after providing written informed consent. The intervention will consist of a weekly text message encouraging women to exclusively breastfeed and inquiring if they have any problems breastfeeding their infants. In addition to text messaging, women assigned to the intervention arm must visit the research site where a research nurse or counsellor will conduct an individual motivational interview, at weeks 2, 6, and 10 post-delivery. Women assigned to the control arm will be counselled by the standard of care service, i.e. primary healthcare nurses and trained counsellors will counsel women to exclusively breastfeed for the first six months through group educational infant feeding counselling sessions. Study participation will not change standard of care of participants, so women assigned to the intervention arm will receive the standard of care service, in line with provincial guidelines applicable in the sector during the study period. The primary outcomes are 1) number of women who are exclusively breastfeeding at week 24 post-delivery and 2) number of women reporting any breastfeeding at week 24 post-delivery. Findings or trial design and statistical issues Although women are individually randomly assigned to intervention and control arms, the standard of care at the primary health care facility may induce a dependency between these participants, also called the group therapy effect. For example, promotion of exclusive breastfeeding in HIV-infected women may be enhanced through positive feedback from women who follow this practice or vice versa. The standard of care will be clustered within group infant feeding counselling session, where participants (both assigned to the control and intervention arm) will receive the standard of care in groups. Women assigned to the intervention arm will receive individual motivational interview and the text messages will be send separately, to each woman’s mobile phone. Implications The trial objective will be to determine whether at week 24 following delivery, weekly text message added to motivational interview leads to better adherence to exclusive breastfeeding and leads to extended breastfeeding than standard of care. Trial design and statistical issues to discuss during the workshop will include a discussion around: 1) the appropriateness of invoking the standard experimental design to address the study objectives, and possible alternatives 2) Sample size estimation for a trial comparing group and individual treatments? 3) Reasonable assumption on the underlying probabilistic model generating the outcome data and 4) Candidate statistical models. Key messages Use of sound statistical principles of experimental design established for clinical trials allow objective and unbiased comparisons.

Correlates of Infant Feeding Practices Among HIV-positive Mothers and Controls in Northeast Nigeria.

Despite the global decline in pediatric HIV infections, infants in sub-Saharan Africa still acquire HIV infection through inappropriate feeding. The objective of the study was to compare knowledge and predictors of infant feeding behavior between mothers living with HIV and controls of unknown HIV status in Gombe, northeast Nigeria. A cross-section of clinic-based samples of 84 HIV-positive mothers and 170 controls of unknown status were interviewed using validated questionnaires. Knowledge scores and self-reported infant feeding practices were analyzed. Multivariate logistic regression models were employed to determine predictors for infant feeding practices. Transmission risk perception (95.2% vs. 65.3%) (p<0.05) and adequate knowledge of infant feeding (77.4% vs. 51.2%) (p<0.05) were higher among HIV-positive mothers than controls. Compared with mothers of unknown status (56.5%), a higher proportion of HIV-positive mothers (84.5%) reported breastfeeding the index infant exclusively for 6 months (p<0.05). In contrast, mixed feeding was more prevalent among controls (19.4% vs. 4.8%) (p<0.05). Further, over a third (39.3%) of HIV-positive mothers and 27.6% of controls weaned their infants at ≥12 months (p>0.05). Antenatal attendance, hospital delivery, knowledge, and positive attitude predicted infant feeding practices in both groups. The predictive roles of education and parity were limited to HIVpositive mothers, while the effects of maternal age and infant death were restricted to controls. Risk perception, knowledge, and exclusive breastfeeding rates were higher among mothers living with HIV. Antenatal care, hospital delivery, knowledge, and attitude predicted infant feeding practices in both groups. Girl child education, antenatal care, hospital delivery, and sustained promotion of exclusive breastfeeding with antiretroviral therapy are key to HIV-free infant survival.

Effects of community-based interventions on exclusive breastfeeding among lactating women: a systematic review

Improvement in the exclusive breastfeeding (EBF) rates until 6 months have been proved to be a major contributor in the improvement of child survival over last two decades because EBF provides optimal nutrition for early life. However, most of the low-income countries (LIC) and low-middle income countries (LMIC) are below the 90% benchmark set by World Health Organization. Evidence regarding CBIs for EBF among lactating women with infants &lt;6 m was searched in PubMed and Cochrane library. Studies from LICs and LMICs that reported EBF until 6 months as outcomes were included and their results were analysed. Data extraction included characteristics of the studies and full summary that involved the effect of interventions on the outcomes. Of 5,530 studies initially identified, 25 studies were included for the systematic review. The interventions were community-based that focused on breastfeeding practices among lactating women with infants &lt;6 m. The studies were geographically diverse-involved LICs (n=7) and LMICs (n=11). The population ranged from n=12 to 26,262. Of 25 studies, five types of interventions reported- counselling interventions (n=14), training to peer counsellors (n=2), mass media interventions (n=5), mobile phone Interventions (n=1), and EBF promotion and education (n=3). CBIs could substantially increase the rates of EBF. The review identified five types of CBIs, indicating that there are different ways through which high EBF rates could be achieved. Counselling intervention was more effective but other interventions have also shown significant results in improving BF practices.

Knowledge, Attitude and Practice of Exclusive Breastfeeding amongst Mothers of Infants in Gwagwalada Area Council, FCT, Abuja, Nigeria

Exclusive breastfeeding provides nutritional, and developmental psychological advantages with regard to general wellbeing of an infant and has dramatically reduced infant deaths in developing countries. This study assessed the Knowledge, Attitude and Practice of Exclusive Breastfeeding among women attending antenatal clinic in four communities within Gwagwalada Area Council of FCT, Abuja. The questionnaire sought socio-demographic information, Religion and cultural influence as well as knowledge and awareness level of EBF practice. The data collected was analyzed using Odd ratio, frequencies and simple percentages. The result of the study showed that 70.0% had the knowledge of exclusive breastfeeding, 54.4% exclusively breastfed their newborns for the first six months of life. There was positive attitude among the participants towards exclusive breastfeeding as 70.0% of them agreed that breast milk alone is sufficient for the baby during the first six months of life. There was high level of knowledge on exclusive breastfeeding among therespondents, almost half of the participants practiced exclusive breastfeeding and relatively all the respondents had positive attitude toward exclusive breastfeeding. However, Illiteracy (60.0%; OR = 1.5) and Culture (66.7%; OR = 2.0) negatively influenced exclusive breastfeeding in the area council. Although, majority of the women in this study had good knowledge and attitude towards Exclusive Breastfeeding (EBF), the practice is not high. There is still need for improvement. More awareness on the benefits of exclusive breastfeeding must be emphasized in order to increase the knowledge and compliance of the women as only 54.4% actually practiced it. Promotion of EBF should involve programmes that will capture not only nursing mothers and health workers, but other members in the communities, most especially husbands and older women who are involved in child care.

PREVALENCE AND PATTERNS OF ACUTE WATERY DIARRHOEAL ADMISSIONS PRESENTING TO A TERTIARY HOSPITAL IN SOUTH-EAST, NIGERIA

Background: Globally, acute watery diarrhea (AWD) is a major cause of childhood morbidity and mortality. It is the fourth leading cause of death in children contributing as high as 11% of all childhood deaths. In Nigeria, AWD causes 240,106 under five deaths per year despite the interventions aimed at preventing diarrhoea disease.  Objective: This work was to determine the prevalence and patterns of acute watery diarrhoeal admissions among children presenting to Nnamdi Azikiwe University Teaching Hospital (NAUTH), Nnewi, Anambra state, Nigeria. Methods and Materials: This was an observational study. Children aged 6-36 months, admitted for acute watery diarrhea, who met inclusion criteria and whose caregivers gave informed consent. The caregivers of these children were interviewed using interviewer-administered questionnaire. Information obtained included socio-demography (age, gender, social class among others), symptoms of diarrhoea, duration of illness and medications given to these children at home. Data were analyzed using SPSS 21. Results: Of the159 study participants admitted for AWD, 103(65.0%) were males. Those of lower socio-economic class comprised 66.6%(106) while 49(30.6%) and 4(2.8%) belonged to the middle and upper socio-economic classes respectively. A total of 921 inpatients were admitted for the period of the study (January 2017 to October 2017), giving an AWD prevalence of 17.3%(159). The highest number of admissions occurred from January to March 2017, with highest prevalence in March. There is poor utilization of oral rehydration solution (40.3%; 64) with abuse of antibiotics in the home management of diarrhea. Conclusion and recommendations: The result of this study showed that the prevalence of AWD is still unacceptably high. Interventions aimed at prevention (such as promotion of exclusive breastfeeding, health education on hand and environmental hygiene, and inclusion of rota virus and cholera vaccine in our national program on immunisation etc) should be encouraged and strengthened by the policy makers and monitored for proper uptake by the populace. Key words: Prevalence, Acute watery diarrhoea, children, Admissions

Fertility in North Sumatera: Why is it not declining?

The results of the Indonesia Demographic and Health Survey (IDHS) in 2017 confirm that although the prevalence of contraception is quite high, the fertility rate in North Sumatera Province is still high. Fertility decomposition analysis has been used extensively to identify changes in fertility in various countries. This study was conducted to determine the pattern of changes in fertility decomposition in North Sumatra by using IDHS data in 2002/03 and 2017. The total fertility rate (TFR) from 2002 to 2017 in this province relatively remains the same, which is around 3 children per woman. There was a change in the proximate contribution of the determinant of fertility. Contraceptive use and effectiveness are the main contributors affecting the fertility rate in North Sumatra Province. The contribution of breastfeeding patterns has increased and marital patterns have decreased over a period of 15 years. The implementation of population and family planning programs in North Sumatra Province needs to be continuously improved to reach a TFR of 2.1 children per woman by 2024. Promotion of exclusive breastfeeding needs to be encouraged to extend the birth interval and reduce natural fertility. Prevention programs for child marriage and teenage pregnancy should be promoted.